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HomeMy WebLinkAbout2019 ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK '"' ;";.' " =`u°?r° '.° P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 .,.,, ER Telephone 631 765-1800 MARRIAGE OFFIC ��, � � .., '�, p ( ) RECORDS MANAGEMENT OFFICER af . �' www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT#3 of 2019 PUBLIC DISPLAY 0-F_FIREWORKS 1, ELIZABETH A. NEVILLE,Town Clerk of the Town of Southold,Suffolk County, New York, being an officer duly designated by the Town Board of the Town of Southold for this purpose, do hereby GRANT TO: GREENPORT FIRE DEPARTMENT PIIOEN1k iF1()tDK'&:LADDER;JHt1tC1sttEE'f;'G tEENPORT, A-PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal.Law of the State of New York at 10.00-PM-on-Thursday,.July 4, 2019; (Raindate:10:00PM, Fridays July, 5, 2019) and 10:00PM__on_Saturday, lulu 6, 2019 on the property of GREEfVPORT-P,U'BL[C SGHOOL.Athtet[c_Field; located on the north side Front Street -and east side Moores. Lane, Greenport ;: IVew York.^ ON CONDITION THAT the bond(indemnity insurance)required shall continue in full force and effect in favor of the Town of Southold,and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad,or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the failing residue from the deflagration will fall in to such lake or body of water;that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years,competent and physically fit for the task,that there shall be at least two such operators constantly on duty during the discharge and that at least two soda acid , or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. Eliia'b h A. Neville,Southold Town Clerk uffolk County, New York (Town Seal) Dated:June 6, 2019 _ 4 CHIEF JEFFREY WEINGART 1> (631)477-9801-STATION 1 15TASST.CHIEF SUSANO JIMENEZ (631)477-8261-STATION 2 (631)477-1943-CHIEFS OFFICE 2ND ASST.CHIEF JAMES KALIN f (631)477-4012-FAX CHAPLAIN CLAUDE KUMJIAN - 311 THIRD STREET•P.O.BOX 58 GREENPORT,NY ASST.CHAPLAIN THOMAS MURRAY Email:gfdfire@opton 11944 reQoline.net SECRETARYfrREASURER JAMES KALIN X _ www.greenportfd.org Organized 1845 P; JUN 4 =:1 June 3, 2019 Southold Town Clerk To Whom it May Concern, The Phenix Hook&Ladder Co.#1 and the Relief Hose Co.#2 of the Greenport Fire Department will behaving fireworks.display s on Thursday,July 4, 2019 and Saturday,July 6,2019. A rain date will be Friday,July 5, 2019. The displays will be shot from the athletic fields of the Greenport Public School. Greenport Fire Department will be standing by with two (2)fire engines, one (1) ambulance and any additional apparatus as needed. If you have any questions please feel free to contact me at the phone number above. Sincerely, _ James H. Kalin 2nd.Ass't. Chief J auero . RESOLUTION 2019-519 ADOPTED DOC ID: 15295 A THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-519 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 4,2019: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit#3 of 2019 by the Town Clerk to Phoenix Hook& Ladder Company 1 & Company 2 of the Greenport Fire Department for a fireworks display at 10:00 PM on Thursday July 4,2019 Rain Date of. Friday July 5,20191 and 10:00PM Saturday July 6, 2019 (no raindate) at Greenport High School's Athletic Field located on the north side of Front Street and the east side of Moores Lane, Greenport,New York upon the payment of a single fee of$100 per event and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits and subject to the approval of the Town Attorney and the Chief of the Greenport Fire Department. a Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell CHIEF JEFFREY WEINGART ? '`" (631)477-9801 -STATION 1 1ST ASST.CHIEF SUSANO JIMENEZ (631)477-8261 -STATION 2 (631)477-1943-CHIEFS OFFICE 2ND ASST.CHIEF JAMES KALIN (631)477-4012-FAX CHAPLAIN CLAUDE KUMJIAN 311 THIRD STREET•P.O.BOX 58 ASST.CHAPLAIN THOMAS MURRAY s GREENPORT,NY 11944 Email:gfdfire@optonline.net SECRETARY/TREASURER JAMES KALIN www.greenportfd.org Organized 1845 RECEIVE® rk,A JUN 4 20% F� June 3, 2019 Southold Town Clerk To Whom it May Concern, The Phenix Hook& Ladder Co. # 1 and the Relief Hose Co. # 2 of the Greenport Fire Department will be having fireworks displays on Thursday,July 4, 2019 and Saturday,July 6, 2019. A rain date will be Friday,July 5, 2019. The displays will be shot from the athletic fields of the Greenport Public School. Greenport Fire Department will be standing by with two (2)fire engines, one (1) ambulance and any additional apparatus as needed. If you have any questions please feel free to contact me at the phone number above. Sincerely, C� James H. Kalin 2nd. Ass't. Chief f Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, ay 22, 1l3 To: Du , Bil her, R� ert; Flatin, Spi elissa; Dinizio,James; Doherty, Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Subject: FinaiIing FirpwrirkcBpfarral-7 7(119(15?9QA17R1 Attachments: FireworksReferral-7_20190522091733.pdf Attached, please find an application for a Fireworks Permit for the lu1���019_Gre_enn Fire Dar me t Phoenix9__neenn Fire Deme t Phoenix 1-165M& Ladder Co. Please review and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: FireworksReferral-7 20190522091733 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 Neville, Elizabeth From: Eishe_r. RoJ_e.Gt Sent: Friday, May 24, 2019 12:36 PM To: Neville, Elizabeth; Duffy, Bill; Flatley, Martin; Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa;Ghosio, Bob; Ruland,William; Russell, Scott Subject: RE: Emailing: FireworksReferral-7_20190522091733 Betty I Have no problem with this event taking place as submitted. Bob -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 22, 2019 11:35 AM To: Duffy, Bill<billd@southoldtownny.i;ov>; Fisher, Robert<Ro,bert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James <iames.dinizio@town.southold.nv.us>; Doherty,Jill<jilt.doherty@town.southold.ny.us>; Evans, Louisa <louisae@southoldtownny.eov>; Ghosio, Bob<bob.ghosio@town.southold.ny.us>; Ruland, William <williamr@southoldtownny.gov>; Russell,Scott<scottr@southoldtownnv.gov> Subject: Emailing: FireworksReferral-7_20190522091733 Attached please find an application for a Fireworks Permit for the July 4 2019 Gre nnort Fire Department Rhoeniv Hook& Ladder Co. Please review and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: FireworksReferral-7 20190522091733 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 Neville, Elizabeth From: _Jatlev. Martin Sent: Wednesday, May 22, 2019 12:39 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert; Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Subject: RE: Emailing: FireworksReferral-7_20190522091733 I have no objections to this event being approved. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 22, 2019 11:35 AM To: Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.nv.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Dinizio,James <iames.dinizio@town.southold.nv.us>; Doherty,Jill<iill.doherty@town.southold.nv.us>; Evans, Louisa <louisae@southoldtownny.Rov>; Ghosio, Bob<bob.Rhosio@town.southold.nv.us>; Ruland,William <williamr@southoldtownny.gov>; Russell,Scott<scottr@southoldtownnv.Rov> Subject: Emailing: Fireworks Referral-7_20190522091733 Attached, please find an application for a Fireworks Permit for the July 4, 2019 Greenport Fire Department Phoenix Hook& Ladder Co. Please review and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: s. FireworksReferral-7 20190522091733 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 . T Neville, Elizabeth From: iro Melissa Sent: Wednesday, May 22, 2019 11:51 AM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert; Flatley, Martin; Dinizio,James; Doherty,Jill; Evans, Louisa;Ghosio, Bob; Ruland,William; Russell, Scott Subject: RE: Emailing: FireworksReferral-7_20190522091733 This is not Town preserved land. Melissa -----Original Message--=-- From: Neville, Elizabeth Sent:Wednesday, May 22, 2019 11:35 AM To: Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.nv.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James <iames.dinizio@town.southold.nv.us>; Doherty,Jill<fill.doherty@town.southold.nv.us>; Evans, Louisa <louisae@southoldtownny.gov>; Ghosio, Bob<bob.shosio@town.southold.nv.us>; Ruland,William <wiIlia mr@southoldtownny.eov>; Russell,Scott<scottr@southoldtownny.gov> Subject: Emailing: FireworksReferral-7_20190522091733 Atta;hgd,_pJgase find an application for a Fireworks Permit for the July 4, 2019 Greenport Fire Department Phoenix Hook& Ladder Co. Please review and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext.228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: FireworksReferral-7 20190522091733 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. i FROM LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:28PM P2 EI.:IGASIF B A.NrEViLLE,MMC ��� 'Town lul. Road TOWN CLIFF-i o � P,p.Box 1179 cc as S uLhold.l e.w York 11971 REGI.WRAR OF WrAL STATI..111CS p + F��(6S 1)76,5-614.'i 2NL%RH AGE OF'F'ICER �ifi �Q�' 1101cphone(631)765-1800 RECORDS OF MANAG MEAPP OFFIC1 R routlholdtrnvn.norl.LCur1..;%at FREE OU OF W- ORl�I,t TIO OFFICER Ob`b m OF THE TOWN CLERK TowN OF SOUTHOLD APPLICA'T'ION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MViADE, pursuant to the provisions of Section 405.00 of the Penal Law of the Statc of New York,for a permit todisplay fireworks as hercinafler specified: Relief HoS9 DISPLAY IS TO BE SPON. SORER BY Phenix hook & Ladder Co. #1 Co'.*. #2. PRINCIPAL OFFICE AT 3xd Street Greenport, NY 11944 IDA-rig&TIME OF DISPLAY 7172099 StartTimed o PM EXACT LOCATION OF DISPLAYGreenport High School Athletic Field. SUFFOLK COUNTY TAX MAP NUMER FOR SITE RAIN DATE&TIME NIA Start Time: PM The following persons are to be in ohne of the actual shooting of the fireworks; Name Age Experience Physical Condition Lee Becker 50 10+Years _ ,.'� Excellent -- (Additional names and informwion may be subraitted on an attached sheet Number and type of fireworks is as follows: Approximately (9.300 Shots) 1.S" - 5" Manner andY place of storage of fireworks prior to display: In a NYS Licensed Magazine @ Legion Fireworks Co. , Inc. 10 Legion Lane Wappingers Falls, NY. Attached hereto and made a past of hereof is a diagram of the gmunds on which the display is to be held. Also-attached is a certificate or policy ofinsurauce coverage. NOTICE.: Written permission,with signature of the fteverty Owner,must be submitted with the Application. �� � L—� rd LIL o ._ � FEE: $100 �am of Ors *7xtion See policy -for additional information sy M. . ignature of Applicant Date of Application FROM ,: LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:24PM P2 �O�g P `sown 1{Q(l.:s,()<)9 Main Road M,IZABE TH A-IgEVUJ.E,MMC Id P.O.Box 1179 TOWN Ct.,Ii,RY. to 'ILI Southibld,Nc%v York 11971 REGIS'T'RAR OF VITAL STA rnwiC.S d � oft Fax f6�1)i6.S-6145 vIARRrAGE OFFICER ��' Thlepho o(&:31) ItF:C:OIZDSOpmMAGEMENTOFFICER 1 ''� Foutholdc wn.s10 }EIV E U F MWOI°I OF L,71'- PUMAZOIN OFFICER OFk-ICE OF"M TOWN CIfMK MAY 2 1 2019 TOWN OF SOUTHOLI) APpI.ICATIflN PERMIT TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisibns of Section 405.00 of the Penal Law of the State ofN. ew York,for a permit to display fireworks as hereinafter specified_ Relief Ho se DISPLAY IS TO BE SPONSORED BY Phenix Hook & Ladder Co. #1 & Co.' 92. PRINCIPAL OFFICE AT 3rd" Street Greenport, NY 11944 DATE&TIME OF DISPLAY 7/412019 Start Time: DPM _ EXACT LOCATION-OF DISPLAYGxeenport High School Athletic Field. suipFOLK COUVrY'TAX MAP NUMBER FOR SITE RAIN DATE& 2099 Start Time: PM The following persons are to he in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Lee Becker �...__------- $0. 10+Ycars ---�W Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Approximately ( 1.820 Shots) I-S" - 5" �. Manner and place of storage of fireworks prior to display: In a NYS Licensed Nagazine @• Legion Fireworks, Co_ , Inc. 10 Legion Lane Wappingers Falls, NY. Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,with signature of the ertY Owner,must be submitted witb the Application. 'Zg sn_ c2 FEE; $100 f Organ t10 See policy-for additional information By 9. i Signature of Applicant oQ®a ')0 l --- D of Applies Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/22/19 Receipt#: 254471 Quantity Transactions Reference Subtotal 1 Fireworks 7.4.19 $100.00 1 Fireworks 7.6.19 $100.00 Total Paid: $200.00 Notes: Payment Type Amount Paid By CK#1411 $20000 Greenport, Fire Department Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Greenport, Fire Department Po Box 58 Greenport, NY 11944 Clerk ID: BONNIED Internal ID:7.6 19 • s Fi r 'S • 3 yr • V • t, t 1� � • Ai np ! ;c psi r •Y r f r r ,1 • i}S.. K 1411 GREENPORT FIRE DEPARTMENT 2,oss;o PHENIX HOOK&LADDER CO. IDATE 120 .vol , 212 KNAPP PLACE GREENPORT,NY 11944 aaa. w Pnf TO . RISE or „•,,�, CHASE j JPMorgwwwC an Chase Bank,NA. I www Chase. MEMO .x, a t GREENPORT UNION FREE SCHOOL DISTRICT 720 FRONT STREET GREENPORT,NEW YORK 11944 D Request to Use Building and/or Groun M YO 6 1019 BY Date Submitted: Areas to be used (check all that apply): "Subject to availability when not in use by the school ❑ ❑ Classrooms ❑ Gyms Fields&Grounds ❑ Front Lobby Auditorium (Please Specify (Please Specify) (Please Specify, (Including Rooms) including Front Hallways) Driv ❑ Other Organization and Event Details Name of Organ.M-, ri: .bt - �� Email: Address: -- - - -Telephone:- Event Telephone:Event Supervisor: Name of Event- Time Gvo✓� :s /a U iS �. S Time of Use:Date: UMIA aDl�_ 4m Time: � Number of Participants Expected: �Od Will the Event be Open to the Public: Is this a FOR PROFIT Organization: Admission Charge Amount: Purpose of Admission Charge: - r Will refreshments be served?Give details: Specific Equipment and Services Needed Number of Tables Needed: Where Placed: Number of Chairs Needed: Where Placed: Lighting(Auditorium): Sound(Auditorium): Gymnasium Bleachers Needed: Other: AGREEMENT: The undersigned is over 21 years of age and has read this form and attached regulations and agrees to comply with them:He/She agrees to be responsible to Greenport Union Free School District for the use j and care of the facilities.He/She,on behalf of the user organization does hereby covenant.and agree to defend;indemnify and hold harmless the District from-and•against any,and all liability,loss,damages, claims,or actions(including costs and attorney's fees)for bodily'injury and/or property damage,to the extent permissible by law,arising out of or in connection with the actual or proposed use of the District's pr erty, cilities and/or services by the user organization. S,6-�� Signature of Organization's Representative Date Print Name of Organization's Representative Date Approved Disapproved nature S e tenden Date } Revised 7/31/18 FROM : LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:32PM P8 I.&Department of Juctice (18 � .S C Chapter 40) ,a=u ofAleobol,Tobacco,Firearms and Explosives tl>Ai9e®°islow�a�a°etlt°«� 1 seemdance w'itli the provisions of Title Ml Organised Crirne Control Act of 1970,and the reguWions rssved fhBTV?)1)�CIJt Past 555).you maY engage in 'le activity spocified in this Iiccnsc or permit within the hmautions of Charter 40.Title 18,United Statm Code and the regulations issued thereunder,until the xpiration date shown. THIS r.ICTN' US tiNM FA NSl+>FRAIIiI.E rr4. ..R 27 CFR X45.43. See"WARNTINGS"and'NOTICES"on reverse. )irxt A fl; ATF-Chief,1.1;lk Li�en5c'P:riu7t ;orsespondencc To �4 Needy Road Numbi7: 6-NY-027-51-2C-00091 Maatinsburq,'WV 25405-9431, ;hief,Federal Explosives licensing Center(FEL EXPiratiiin 1 LEGION FIREWORKS CO INC. " prisjlises AddreSS(Cbanges?Notif}-the'.k" x Ciel'-le�ast';'10 daySfi�efare ilie�bve:):x 10 LEGION LANE �'`:' `r :;f ;.;••"' .a-::t, ' WAPPING ERS FALLS, NY..1259.0 ': �:``;;:r ;N•_> -..,,,. b1n of License or Permit ,;:. . ;,,• „ -,:•; {' 51-IMPORTER OF EXPL0Siril10§'r":-.4. S.a' i- :"t' Addicess(Changes?;Notify the XEI.0 of any changes.) 1'suhhaszngCertificatiot{'S�4ieineit �i;:';"`;'�• Mallin 1 iclicansee or pcizi ittee aarnod above shall use a copy"qf thfis icc nse lramfercr: losives to ucsify the idw ity andthe-lici'uge$staNs of&" ioenst'e6r•"'�<, - -. ,; �..::: r petmi¢eesspyovidcdby27CFRP,tt555. Thesienaiiiri:, ir'c2pymuscbeaa•vnfiNii` :LEGIONFIREWORKSGOINC si refalaed,scanned or encoded copy offfic liccasezoti. c'4n1t�►v11b•a ai�ture : •y;, eitmded to be as originaltsauc is ofthe Fodzr acceptable. The sj919 bd dWsi"ie tl}a� ail 10 LEGiOI�I.:l14NE F,Nplosivcs Licensee,(FEL)or a reTowsible pas;=of the FEI:-;l ocstd'j'.tliat this,is a true W,APPI IVC�E`RS'FALLS. NY 12590- n o£a1i pamitisstiodso licaa isee mityCtent? ;Wtoen5nf bsi¢ets«!' �ans speeifi uAder C O CCIISe OL 1'air1R°'• 4: ': .. w ;,, r: .•. I ' V. LiecnseePermittee Responsible Pcrson Signature Posi1i6rt'Title Printed Name nate ATF Form 54(91.1":.00.15 Pars 1 ?revaeus Revised Oetobcr 2011 is ,ao.mncnmscnar,o°mouu�,reo�xrarras-ic „�a,.mas,dMroartzo�t�swnis Feder d Explosives Xicense(FEL)Custoriier service hdormation Fodcral.F_tiplosives Licensing.Center(FE1.C) Toll-free Telephone Number. (977)293-3.352 AIF Homepage:w%w stf-zov ?A4 Need)-Road Fax Number: (304)616.4401 Martinsburg,W. V 25405-4431 E-mail: M, C@atfg C im*e ofA.ddress (27CFR 555.54(c)(I)). Lfecnsacs or permittees may during the term of their current license or permit remove their busine;Q;or operalions to a new location at which they intend regularly to carry on such business or operadow. The licensee or permittee is required to give notification of the new location of the busitrpss or operations not less than 10 days prior to such removal with the Cbidf,Federal F_\-plosives Licensing Center. The license or permit will be valid for the remainder ofthe term of`thc original license or permit. (Me Chief,FF.LC,shall,if the licensee or permittee is not qualified,refer the request for amended Gcemw or perimt to the Director of Industry Operations for denial in accordance with§555.54.) Right of Succession (27 0,R 555 59�. (a)Certain persons other than the licensee or permittee may secure the right to carry on the some explosive materials bu'sincss or'opers6ons at'the same address shown on,and for the remainder of-the term of,a current license or permit. Such persons are: (1)1 he surviving spouse or child,or cxecutor,administriaor,or other legal mpresetitarive of a deceased liccusce or permittee:and(2)A receiver or trustee in batrl,7ruptey,or an assigned for benefit of cteduors. (b)In order to secure the right provided by this section.the person or persons continuing the business or operations st1a11 furnish the license or permit for-for that business or operations for endorsement of such succession to the Chicf FELC,within 30 days from the date on which the successor besjns to cam•on the business or operations. (CvnlrRrrod o»reverse sadsi CutHereX I--- -- - ----------------------r I 'Federal)Explosives L'iecnsdPeiimnt(F)PL)Information Card I l LicensrlPermitName:LEGIO(.1•RgF WOF KS CO INC I I BusincssName: .... ., I j Liocn.=permit Number:ra*Y-027-51-2c-00661 t I Licence/Permit Type:bl4MPORTER of EXPLOSMS Expimion: March 1,2022 j i ! I Please Now Nottt Adfior the Sale or Other Dispositicn of EaPlosives. i t t GREENPORT UNION FREE SCHOOL DISTRICT 720 FRONT STREET GREENPORT, NEW YORK 11944 T. Request to Use Building and/or Groun M y 0 6 7019 f3y Date Submitted: , (Q o10 lQ 6� Areas to be used (check all that apply): "Subject to availability when not in use by the school ❑ ❑ Classrooms ❑ Gyms Fields&Grounds ❑ Front Lobby Auditorium (Please Specify (Please Specify) (Please Specify, (Including Rooms) including Front Hallways) Driv ❑ Other Organization and Event Details Name of Orgauj tion: � "- C64.P - A' Email: Address: Telephone: - Event Supervisor: Name of Event- Time of Use:Date: ��.1J�S/U �9 Time: Y/1/1 Number of Participants Expected: SOD Will the Event be Open to the Public: lis Is this a FOR PROFIT Organization: Admission Charge Amount: Purpose of Admission Charge: Will refreshments be served?Give details: N Specific Equipment and Services Needed Number of Tables Needed: Where Placed: Number of Chairs Needed: Where Placed: Lighting(Auditorium): Sound(Auditorium): Gymnasium Bleachers Needed: Other: AGREEMENT: The undersigned is over 21 years of age and has read this form and attached regulations and agrees to comply with them.He/She agrees to be responsible to Greenport Union Free School District for the use and care of the'facilities.He/She,on behalf of the user organization does hereby covenant and agree,to defend,indemnify and hold harmless the District from and against any and all liability,loss,damages, claims,or actions(including costs and attorney's fees)for bodily injury and/or property damage,to the extent permissible by law,arising out of or in connection with the actual or proposed use of the District's pr erty, cilities and/or services by the user organization. Signature of Organization's Representative Date ?12—+1-1 LC r, S -5_(�;-(g Print Name of Organization's Representative Date Approved Disapproved 0// nature' S tenden Date Revised 7/31/18 FROM LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:25PM P4 DATE(MMIODNYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 5/1/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT- If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed_ If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require an endorsement_ A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. CONTACT PRODUCER NgME;_ Britton Galla g her PHONE F^x (/uc,No):29EL-6�a_71o1-- One Cleveland Center,Floor 30 E-MAIL 1375 East 9th Street ADDRESS.—__.. ___�__--—.. ., -•-- Cleveland OH 44114 INSURERS)AFFORDING COVERAGE MAIC 9 , INSURERA us„Ins C =am _ INSURED INSURER B:Everest N�tign2l,InsldTr7nce Legion Fireworks Co_,Inc_ INsYPAR C: _• __. _ _ 10 Legion lane INSURER D: -_-- Wappingers Falls NY 12590 INSURER E•^ INSURER F: COVERAGES CERTIFICATE NUMBER:800056320 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. a SM . 1. . _ _WPOiICV EFF POLICY EXP LTR TYPE OF INSURANCE ik= WVD POLICY NUMBER MIWO MMID Y LIMITS B GENERALLIABILITY S18MLOO116-191 3/15/2D19 3/15/2020 FAC”OCCURRENCE S1,000,000 X COMMERCIALGENERALLIABILITY PREMISE mncr $�0�000 CLAIMS-MADE X❑OCCUR MED EXP(Any one porion)•,_• $ __•__ PERSONAL&ADV INJURY $1,000,000 _ ~ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP ACiG $2,000,000 F. POLICY X PRD 71 LOC $ COMBINrUSINGLrElMil B AUTOMOBILE LI BUff SIBCA00058-191 3/1512019 3/1512020 amdenl _ _— $1,000,000 _ X ANY AUTO BODILY INJURY(Per-pawn) S -ALL OWNED SCHEDULED BODILY INJURY(Per aoddonl) S AUTOS AUTOS PROPERTY DAMAGE — X MREDAUTOS X AU NEO Iefl�J3lS�D®TIN _— g.__ A =:Rr;"ALIAR X O UR P-001-000091849-M 3/1512019 3/1512020 EACH OCCURRENCE $4.000,000 X EXCESS LIAR CLAIMS�WDE ACGRFGATE 54,000,000 DED RETENTIONS M $ WORKERS COMPENSATION WCSTATU OTH• AND EMPLOYERS'LIABILITY YfN .1111 1R' - .- -•--- ANYPROPRIETORIPARTNERIEXECUTIVE❑ NIA E.L.EAOHA(4SOENT $ OFFICEP/MEMBER EXCLUDED? (MandatoryinNH) ILL.DISEASE-EA EMPLOYE If yes.describe under 6_L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attnet,ACORD 101,Add,l;onal RamatiM S4h6dol%K mom rpWA lr rmulmdl Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. •Date.6f.Display:7/4/2019 Rain Date:7/5/2019 Location of Display_ Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured: Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 92 CANCELLED BEFORE Phenix Hook&Ladder Co_#1 &Relief Hose Co.#F2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 58 ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Street Greenport NY 11944 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD FROM : LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:29PM P4 DATE(MM/DWYYYY) ACOROW CERTIFICATE OF LIABILITY INSURANCE 4/26/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL.INSURED,the policy(ies)must be endorsed. If SUBROGATION 1S WAIVED,subject to the terms anrt3 condklons of the policy,certain policies may require an endorsement_ A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). TA T PRODUCER NAMES - - PHONE 1 -g;;8-7100 � w Britton Gallagherc,Ivo12]���.710.1_ One Cleveland Center,Floor 30 Al LREss: -- - 1375 East 91h Street Cleveland OH 44114 cINSURER(S)AFFORDING COVERAGE NAIL 9 _ INSURERA;�(i$yT}�[ IUD S InS�Ornps'1Dy/ 26620 INSURFD INSURERS:EV01est National insurance COmDgny._ 2920 _ Legion Fireworks Co.,Inc_ INSURERC,-, - 10 Legion Lane IN5URUR 0: _ _ - • - Wappingers Falls NY 12590 INSURERS: _ -, F-_ INSURER F COVERAGES CERTIFICATE NUMBER:1518658047 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILfR POLICY EFF POLICY EXP LIMI1R TYPE OF INSURANCE y POLICY NUMBER MM/DDIY M B GENERALLIABILFY S18ML00116-181 311512018 3/t5/2020 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES VIVA $500.000 CLAIMS-MADE ED OCCUR MED EXP(Any one rmn) $ PERSONAL&ADVINJURY-- $1,000,000 G ENERAL AGGREGATE - $2000,000 -r GEN*L AGGREGATE LIMIT APPLIES pEk. UCTS-COMPIOP AGO $2 000,000 $ POLICY X PRO El LOC B AUTOMOBILELIABILI Y S18CA00058-191 3115!2019 nt) - $1000.000 X ANY AUTO BODILY INJURY(Per pemon) $ - AUTOWNED SCHEDULED BODILY INJURY(Per ocodent) $ -- NON OWNED I'ttblff DAMAGE g HIREDAUTOS X AUTOS P.,. I: UMBRELLA uAit X OCCUR P-001-000091848.01 3,1512018 3/1512020 EACH OCCURRENCE $A.000,0_00 EXCESS LIAO CLAIMS-MADS AGGREGATE A000,000 W DED RETENTION V'T $ WORKERS COMPENSATION O STATU- H- AND EMPLOYERS'UABILIMY - ANY PROPRIETOR/PARTNER/EXECUTNE Yrs NIA E.L,EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? L,�J (MandaLOry in NH) E L.DISEASE-EA EMPLOYEE 1f ygs.Oesm6e undar DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DB$CRIPnON OF OPERATIONS/LOCATIONS I VEHICLES Iftacrl ACORD 101,AAQitlonal Rem-M Schedule,If more space is regleired) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display:7/6/2019 Rain Date:N/A. Location of Display:Greenport High School 720 Front Street Greenport, NY 11944. Additionally Insured:Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools,and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 58 ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Street Greenport NY 11944 AUTHORIZED REPRESEASTAYM (P 9988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD �l MIM-Nil�, MO.T6 ApLicit N. A 'N t}.y1'+� rya�'rr '3s�".;��: :r�' ?`i.• �:ci'Y�:f� '� '1.#.Vl -ti.�F}C, rx ill. �4� ,�.+ �l er a•r.' I w �.,+ik, v 7w. V L4 Z",L ON ;'ZON-0. In` MR, qV. FROM LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:30PM P5 on Elmworks0.09 Ines Display PYratearhrut:s SincB 1920 n Lane. in rs Fafls 1`•Y 12590 845-831.8328 t t ; Shooter: 'Lee Becker Cell Phone #; (9 14), 760 - 6151 fist; •• 'u •;'::R' '�C„F�'.:i�,��,ty.l;•- '•'•.. r - ,. .ay`;t s, .r��,J`.°"+,�Z��d"!'ij��a;.�3'�'`iy�;,��54!'a�' ,.'..•..:-`;-... .� ,�! `/ S .a iia'�yl•^ , ''. ' i W: •sSn FROM : LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:31PM P7 11.18.Department of Justice C tUU1 11 EXPIOSIVeS License/Permit Bureau ofAlcotlol,Tobacco.Firearms and Isxplosives (18 U.S.L. Chapter 40) limp®�o�1a nem n®�W'cL'�f In accordance with the provisions of Title 7Q Organi ccd Crime Control Act of 1970-and the regulatrovs issued thereunder(2 7 CFR Pact 555),you may engage in the actilmy 5pceitied in tills license or permit within,thc limitations of Chapter 40,Title 18.United States Code and the regulations issued thereunder,until the eupirstion dale Shown. TIIIS LIC'ENS1E IS NOT ANSFERAELE YIIiD .lt 27 CFR 555.53• See"WARNINC'tS"and"NOTICES"on reverse. Direct ATF ATT-'-Chief.FE1.0 Li(;r6h'TPermit Correspondence To 244 Needy Road Nimilbe�. Martinsburg,WV 2 5405-94 31 / 00077 Chief Federal E losives Licensing(,enter(ITL��` F' • apuatibrl .4�v(!'`r''• Date March 1 2022 Name LEGION FIREWORKS CO INC. ; ' ;;"; �.• PremisesAddress(Changes?No*the.FBLQa.iLcas`10days,tirtororltz'iliovel:^ �'t':' ., , `• s°.:,. 10 LEGION LANE ;.:i:• �:; 'i, ,. .; , WAPPINGERS PALLS NY`12b90 Typo of License or Permit •�' >: :) 20-MANUFACTURER OF EXF?LOS�VESC. :1..'S..}• .� . Fwrchasiag C'eCt7ificati6n Stat Marling Address•(Changes. the FELC of any eha es. cwkeenamed above ciipy uFt)ris Iicmae tr Y $ ) 7haasfavr of P o s1tall usa.d orl2.emiitFto assists ?;.,; ;: c•; ' eaplosiVes to verify the ideatuy andtttesGecnseil Brous oftli °J co , "� ,,;; Ir,_c' .• 4. ?aminee as provided by 27 CFR Part 555. Tete s�t'Ert tis a mx cacti eonv mil tie an`urtrin'al'•-r•° ;; nienamm- Afaxed,scanned ore-mailed copy of the asi uiihtre `'; -`L"EGION FIRFEV!%ORl<S CO INC atcndedto be an eri al si um is le. The s' : Sirs goat acceptab x�.aqui'z,inilst`'lii='tharoftlleFed4i•�l• 1Q LEG1QtV,I:A•NE='. Explti'� c+ssee(Fl:i-)orargonsblepersonoftheI-_I ceit�v",ili:tii'this1satrae WAF'PPIVGERS:.FA1_LS NY 1 ,opy of.a license or•patmit is%W tothe licensee or , ' 2590- permiltee s,ariled aligve toenge lathe•,•,:• :: msiaessor o�yrat3ons specified under' c aE 'cense or.Peimit",' `" Liconsco2crmittee Responsible Person Signature Posiri6niTitic-- CaLue-do kk Printed Natne Date - ATF F=sactc►.146400.UPart l 'tevtousBdaienisnbsolete lILIGNI{tLWOAYSrN1Y�10iEOOYl1NLRlY26fPmF;b9C•C(LffJCGeAC�t7lO•NAIM1Gp1ta10«l6rkW Revied0a6ber20ll Federal Explosives 11certse(FEL),C.hstomer Service Information 'ederal Brplosives Licensing.Center(FELC) Toll-free Telephone Number. (877)283-3352 ATF homepage:www.st£gov 4411cady Road FasNumber: (304)6164401 afartiusburg.WV 25405-9431 E-mail: FELCXa•a fgov Mange of Address (27 CPR 555.54(a)(1#. Li(xnsees or permittees may during the tcrin of their Current liceaso or permit remove their'business or opendions to a tow location at w•ldch they intend rrgularly to cam-ort such business or operations. The licensee or permittee is required to give notifi ca&n ofthe new location ofthe )urines or operations-not less than 10 dugs prior to such removal with the Chief,Federal 1lplosives Licensing Center. The license or permit VAH be valid for the cmainder of the term ofthe original Icenee or permit. (The(5def,1FELC,shrill,if the licensee or permittee is not qualified,refer the regitest for amended liocasc )r permit to-the Director of Industry operations for denial int accordance with§555.54,) tight of Succession (27 CFR 555.59). (a)Certain persons other than the licensee or permittee may Qecure the right to carry on the same explWve materials psiuemor•.operations at the same address shown on.and for the remainder ofthc term of,a currCrtt liccuse or permit. Such persons ata (1)The surviving spouse ecluld,or executor,adriVaistr'ator,or other legal representative of a deceased`liceusce or permittee;and(2)A receiver or trustee in bankruptcy,or an assignee for eneht of croditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the beense or i.crmit for forthat business or operations for endorsement of such succession to the Chief,TF.I.C,within 30 days from the date on which the successor begins to any on the,business or operations. fConrinued on reverse sddel Cut Here X Federal`E,xploslves LicensetPerxrrit(I"IEL)I:afomatiron Card r I:�cetlsdPcrmitName:t EMUN t;IREINORKS CO INC $usinessName: LiccnsePermit Number.6-NY-027-2U-2C-WD77 I LioariswPermit Tv pe:2aMANCiI ACTlIRER,OF EXPLOSIVES FLxpkation: March 1,2022 1 ' 'r r YleascNote: Not Valid for the Sole or OtherDisposition at Expinaivas. t .l , FROM LEGION FIREWORKS Co Inc PHONE NO. May. 01 2019 01:31PM P6 f STATE'OF NEW YORK h� f31VISiON.pE.�„_.. DEPARTMENT OF LABOR z ” '. SAFETY AI,NR,HEAL:TH .' N'r LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES ; Expires: 4/30/2020 Legion Fireworks Co., Inc. 10 Legion Lane THIS LICENSE MUST-BE Wappingers Falls, NY 12590 POSTED IN YOUR PNCE OF BUSINESS Frank Coluccio License No D-2310 is hereby licensed to doal in or manufacture explosives in compliance:with the requirements of the Labor Law and industrial Code Rules. Any change in the conditions under which this license is granted may cause it to be revoked. Eileen M.Franko,Acting Director • 0R " THE COMMISSIONER OF LABOR Every person selling,delivering or giving away any explosives must keep at the principal place of business within the state,a record of each transaction,including: t) the NAME or TYPE and QUANTITY of explosives SOLD,DELIVERED or GIVEN Note No license is needed to-purchase smokeless powder,or black powder in quantities not exceeding five pounds for use in firing antique firearms or artifacts or replicas thereof However,dealers MUST post all such transactions on the"Dealer-Manufacturer Report of Explosives Transactions". 2) the DATE OF CACH SALE,DELIVERY or GIF T. 3) the NAMI=,LICENSE NUMBER,and-BUSINESS ADDRESS of the purchaser,donee,or person to whom the explosives were delivered and the firm.'if any,represented by such person. b 4) the NAME,ADDRESS,and LICENSE NUMBER of the person TAKING THE EXPLOSIVES AWAY from the seller or donor. SH-862(5-98) Neville, Elizabeth From: Flatley, Martin Sent: Thursday;April 25, 2019 9:52 PM To: Neville, Elizabeth; Flatley, Martin; Fisher, Robert Subject: Re: Updated Fireworks Permit Information I have no_objections.to this permit being approved=as"in the past Sent from my Verizon, Samsung Galaxy smartphone -------- Original message -------- From: "Neville, Elizabeth" <E.Nevillektown.southold.ny.us> Date: 4/25/19 3:29 PM (GMT-05:00) To: "Flatley, Martin" <mflatle y a,town.southold.ny.us>, "Fisher, Robert" <Robert.Fisher(ktown.southold.ny.us> Subject: Updated Fireworks Permit Information Please--update your file=with_the information in this attachment. Mr. Ed Siben of Greenport Fire Department came in and filed the application by handwriting the application and submitting the same information as last year. Pyro Fireworks just sent me the updated information. There is a slight change in the number and type of fireworks and the name of the person in charge of the actual shooting of the fireworks. Please confirm with me that all of the new information meets with your approval. Thank you. Betty Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971, Tel 631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: Fisher, Robert Sent: Tuesday,April 30, 2019 4:03 PM To: Neville, Elizabeth Subject: GFD Fireworks Betty I have no problem with the revisions to the Greenport Fire Department Fire Works application. Bob 0 �k Robert Fisher Fire Marshal, Town of Southold robert.f isher@town.southolcI.ny.us (W) 631-765-1802 - (C) 631-786-9180 MMIEM AM)CONMENrIAL"AUNICA TIOIV CONF709MIALrTY NOTT&I5. Me deco'wic mail ftwumission is Wazwed only for the use of the inviwdwl or entity to which it is addressed and may contain beloVing to the sendar which isprotectedbypHvikWe,If you are not the untended recipient;you are hereby notified that any d1=1osum,copying,dWrIbuiYan,or the taking of any OCNOn in reliance an the CMAOVI&Of this information issfrktlyprohibited If you have received this trans-mission in exmr, please notify the sender humadiately by a-mailacrd delete the original memaqa Neville, Elizabeth L From: Neville, Elizabeth f Sent: Thursday, pril 25, 2019 3:30 PM To: Flatldy artin; Fisher, Robert Subject: Updated Fireworks Permit Information Attachments: Greenport Fire Department firework application 5-25-19.pdf Importance: High 4 Please update your file with the information in this attachment. Mr. Ed Siben of Greenport Fire Department came in and filed the application by handwriting the application and submitting the same information as last year. Pyro Fireworks just sent me the updated information. There is a slight change in the number and type of fireworks and the name of the person in charge of the actual shooting of the fireworks. Please confirm with me that all of the new information meets with your approval. Thank you. Betty Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631 765-6145 Cell 631466-6064 1 . ELIZ 1W4A,'NEVILI►E;,MMC 7bwn-Hall,63095,MainRoad ,,Towle CLERK Cz P,O.'Box'1178 v� �. Southold',NewYof411971 REGISTRAR OF VITAi;'sTA isucs' p .Zc Fax(631)765=6145 MARRSAGE OFFICER !!'�O �Q�' nlephoae(631),766-1600 Rt,CORDS OF MANAGEMENT OFFICER d . 'j► southoldtown.northfork.net FREEI)ON-OFINFORMATION OFFICER OFFICE OF THE TOWN CLERK -TOWN OFISOUTHOLD- APPLICATION PERMIT TO-DISPLAY.FIREWORKS APPLICATION is-HEREBY MADE; pursuanHo the,provisions,of Section 405.00 of the Penal Law,6f'the State of New York,for a permit to di'splay'fireworks`as hereinafter specified:_ DISPLAY IS,TO BE SPONSORED BY Star Hose'Company-Greenport Fire Department- .PRINCIPAL OFFICE AT P.O:Box 345; Greenport; NY 11944 DATE&TIME OF,"DISPLAY Z/25/1_9@10:0 0 pm EXACT LOCATION-OF DISPLAY Greenport High School Athletic,51eld; SUFFOLK COUNTY TALC MAP NUMBER FOR SITE., - RAIN DATE;&T-IME 5/26/19 @,10:00 pm The followingpersons are to tie in chargeof the actual shooting of the Fireworks: Name Age Experience Physical Condition William Garafola dob; 5•/26,/,75-__ 14 yrs. _ Health_: FxcellPnt assts: tbd (Additional names and information maybe submitted-on an attached sheet 'Number and type of fireworks is is follows:- 13G Fireworks: 2.5"=3"=432; •4."=102. Manner and :place of storage,,of fireworks prior to display: Delivery day, of' -display. Attached hereto,and made a,part-of hereof is n diagram of the grounds on which the-display is to be held. Also attached'is:a certificate or policy of insurance coverage,; .NOTICE, Written',pekadssi6n,with,signatare,of,tbe Property 0tvhij,.must,.be submitted•"with the "APp4cation, FES: $100 1!Iaine of Qrganization. See palicyr'for additional .information ,Paqtepl Nqme,-o ` ..pp,.ican Signature of.A"' leant' e'--rr►ail�address:: ' - - Telephone NlumUer ._Date.of Application ..r.L (1 O��pF SO�ryo . ELIZABETH A.NEVI LLE � l0 Town Hall,53095 Main Rolid TOWN CLEM >� P.O.Bog 1179 REGISTRAR OF VITAL STATISTICS G Southold;New York 11971 MARRIAGE OFFICER • yOQ Fag(631)765-6145 RECORDS MANAGEMENT OFFICER ��,Y Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER C�U ,� southoldtown.northfork.net RECEIVED OFFICE OF THE TOWN CLERK TOWN OF SOUTHOI,D MAR -- 8 2019 APPLICATION PERMIT TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law df the State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED T PRINCIPAL OFFICE AT c, 4r G e ff yA lJ 0 q 4 DATE&TIME OF DISPLAY :5-12C/1-b) _ / O f'14 EXACT LOCATION OF DISPLAY�v2� u Paa 6 S o, r G,►S r 1 SUFFOLK COUNTY TAX NUMBER FOR SITE RARq DATE&TIME . f 2` Za 19 1 C e�-j The following persons are to be in charge of the actual shooting of the Rreworks: Name Age Experience Physical Condition Do � Ary-'L 14 - ,-,x C 064 (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Manner and place of storage of fireworks prior to display: ,,2,�3wnw�ts bv) l�� b'�C>>f�.�+��+g+d Ij� b� ISP�� �K�� w►�s � �hn �� .�r�ctL, Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,with signature of the Property Owner,must be submitted with the Application. 57A s.r jj (P Name of Organization 13y a 7_,J� Signature of Applicant Date of Application ELUADETH A..,NEVILLE,MMC ,�„ ' Town Hall,53095 Main Road TOWN CLERH ® P.O.Box 1179 craw ft Southold,NewTork 11971 REGISTRAR OF VITAL STATISTICS 0-0 Fax(631)765-6145 aIWIA� MARRIAGE OFFICER ' ' Tblephona(631)765-1800 RECORDS MANAGEMENT OFFICER. ��� "�� southoldtown.northfork net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOV?N OF SOUT'HOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405,00 of the Penal Law of the State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Star Hose Company-Greenport Fire Department PRINCIPAL OFFICE AT P.(7. Box 345, Greenport; NY 11944 DATE&TIME OF,'DISPLAY 5125119 10:00 pm EXACT LOCATION-OF DISPLAY Greenport high School Athletic Field SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIME 5126119 @ 10:C10 pm The fallowing persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition William Garafola dob: 5/26/75 14yrs. Healtiz: Excel. lent assts: tbd (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G Fireworks: 2.5"=3"=432, 4"=1.02, Manner and place of storage of fireworks prier to display: Delivery day of display. Attached hereto and made a hart of hereof is a diagram of the grounds on which the display is to be held. Also atfached is a certificate or policy of insurance coverage. NOTICE. Written permission,with signature of the PkLe2 r Owiner,must be submitted with the Application, FEE $100 Name of Organization See policy-4of-' additional information By Printea Name of 7lipplicantsignature of Applicant e-mail address: Telephone Number hate of Application. FDLI( Town Hall,53095 Maim Road ELIZABETH A.NEVILLE,MMC P.O.Box 1179 TOWN CLERK Southold,New York 11971 Fax(631)765-6145 REGISTRAR OF VITAL STATISTICS MARRIAGE,OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtowiitiy.gov FREE-DOM OF INFORMATION Off-ICER OFF,ICE OF THE, TOWN CLERK TOWN OF SO"UTHOLD ' POLICY for the Issuance of FireworksPermits 1. The Town may grant a permit for the display of fireworks by municipalities, fair associations,amusement parks,RPM-0—As or organizations of individuals. Penal Law Section 405.00(2). 2. An "organization of individuals" is a religious,civic,or comparable organization. Op. Atty. Gen No. 200'7-3. 3. Fireworks permits shall indicate that the display must be concluded by 1.0:00 p.m.if held Sunday-Thursday, 11:00 p.m.if held Friday or Saturday, and there shall be no time restriction if held on July 4. 4. No person shall engage in or allow the manufacture, assembly,storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall be accompanied by the following: k a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display; Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of$2,000,000 for public liability and$2,000,000 for property damage; Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); °d) A copy of the contract with fireworks display company; and \,(e)) All applications shall require the approval of the Fire Chief'of the District in which the display will take place and the Fire Marshal before being presented for approval by the Town Board. All applications for a fireworks permit shall be subject to an application fee in an amount 05 of$100.00,together with a processing fee in an amount to be determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. (The above instructions are in accordance with the Penal Law,Article 405 -Licensing and other provisions relating to fireworks.) g�fF0(/r ELIZABETH A. NEVILLE,MMC �y0� ep Town Halt,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER bane(631)765-1800'yea �OTelephone RECORDS MANAGEMENT OFFICER www.soutboldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD INSTRUCTIONS FOR DISPLAY OF FIREWORKS 1. Name of body sponsoring fireworks display. 2. The date and time of day at which the fireworks display is to be held. 3. The exact location planned for the fireworks display,including TAX MAP NUMBER. 4. The age,experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. 5. The number and kind of fireworks to be discharged. 6. The manner and place of storage of such fireworks prior to the display. 7. A diagram of the grounds on which the display is to be held,showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and location of all nearby trees, telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. 9. An indemnity insurance policy with liability coverage and indemnity protection of $1,000,000.00 per person for bodily injury; $1,000,000.00 per accident;$1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks pen-nit is issued. The named insured must read: TOWN OF SOUTHOLD, Thirty (30)Town of Southold POLICY 11. Application for a fireworks permit must be made at least f dMs in advance of the date of the fireworks {li,�splay. (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) A D� PATE(MMfDorcYYr) CERTIFICATE OF LIABILITY INSURANCE 3/5/2019 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of Such endorsement(s). PRODUCER CONTACT Arthur J,Gallagher Risk Management Services, Inc, PHONE FAX 677 Broadway 4th Floor (AIC,No,Ext);_518-869-3535 (Arc Nc}:.518-869-3580 Albany NY 12207 ADDRESS:... iNSURER(SI AFFORDING COVERAGE NAIL# INSURERA James River Insurance Company 12203 INSURED PYROENG-01 INSURER s:Progressive Casualty Insurance Company 24260 Pyro Engineering, Inc. dba Volt Live 999 S.Oyster Bay Rd INSURER,C,..,Lexi ngton Insurance Company 1=9437 Bethpage NY 117€4 INSURER,D.;_.. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER;122861253 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __- INSR:.... ..__ ._.__ -..-. _. 'A06LSLIBRI�..,. _ - .. ... .- ____ _ POLIGYEFF_.' -POLICYE%P - LTR: TYPE OF INSURANCE POLICY NUMBER MMIDWYYYY MMIDOIYYYY LIMITS A - X COMMERCIAL GENERAL LIABILITY '.� 000891360 2/1512019 2!15!2020 EACH OCCURRENCE .$1,000,000 . DAMAGE TO RENTED- CLAIMS-MADE X OCCUR PREMISES(Ea,occurrence). S 100,000 MED EXP(Any one person) s Excluded PERSONA!,&ADV INJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S2,000,000 PRO- X POLICY - JECT LOC i '., - PRODUCTS.COMPIOP AGG $2,000,000 X OTHER: Hired&Non-Owned Auto 51,000.000 B AUTOMOBILE LIABILITY :00440915-0 211512019 2115/2020 COMBINED SINGLE UMfT s 7.000,fl00 (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED - ... . .. AUTOS ONLY ;AUTOS - BODILY INJURY(Per accident).S X HIRED X NON-OWNED - - PROPERTY DAMAGE �5 AUTOS ONLY AUTOS ONLY - per accidoni) S C X UMBRELLA LIAR XOCCUR 023627359 211512019 2/1512020 EACH OCCURRENCE S9,000,000 EXCESS L1A6 CLAIMS-MAGE AGGREGATE... . ._ S 9,000,000 DEO X RETENTIONS S WORKERS COMPENSATION, PER AND EMPLOYERS'LIABILITY Y f N __i.STATUTE_; EERH ANYPROPRIETOFt1PARTNER1ExECU71V@ E.L,EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? N 1 A {Mandatory In NH) E.L.DISEASE•EA EMPLOYEE S If yes,describe under _ P DESCRIPTION OF OPERATSONS below E.L.DISEASE•POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) FP5201-8112 Additional insured-Automatic Status When Required by Written Contract(includes Waiver of Subrogation and Primary-Nan-Contributory when required by contract) Date of Display:May 25,20'18 Location of Display:Greenport High School,Greenport,NY. Greenport Fire Department:Star Hose Company;Village of Greenport;Town of Southold;Suffolk County;Greenport UFSD are hereby named as additional insureds with respects to general liability coverage as required by contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL€CY PROVISIONS. Greenport Fire Department PO Box 345 Greenport NY 1'(944 AUTHORIZED REPRESENTATIVE ,j/I[/�r'/"'/// ©1988-2015 ACORD CORPORATION. All rights reserved. ACO RD 25(2016103) The ACORD name and logo are registered marks of ACORD New York State insurance Fund Workers'Conopensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 753444987 i PYRO ENGINEERING INC DBA BAY FIREWORKS �I ' 999 S.OYSTER BAY RD, STE 111 BETHPAGE NY 11714 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PYRO ENGINEERING INC GREENPORT FIRE DEPARTMENT DBA BAY FIREWORKS PO BOX 345 999S.OYSTER BAY RD, STE 111 GREENPORT NY 11944 BETHPAGE NY 11714 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 573598 02/15/2019 TO 02115/2020 3!6!2019 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2437 559-4, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS.1/WWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY, NEW YORK STATE INSURANCE FUND D3RECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 519035445 U-26.3 m—,ra ?�.,5 .,rr�i,� 3 ,rc, .i=24 PYRUTEC" 1-0 a NICIAN" CE" lilt tr �S A HMO I nvffl MR A NAT a u� a r� ` 4� s R � v F h - e w �t - } '� FAA/Air Traffic Organization 1701 Columbia Avenue Eastern Service Center College Park,GA 30337 U.S. Department of Transportation Federal Aviation Administration Dear Fireworks Proponent: fAA-Greenport FD 2019 Thank you for inforining us of your proposed fireworks display. Although there are currently no federal regulations specific to fireworks displays,the federal Aviation Administration(FAA) has been tasked with regulating the safe and efficient use of the navigable airspace (49 U.S.C.§ 40103). In recognition of this role in promoting aviation safety, many jurisdictions require notice to the IAA as a condition of approval of fireworks permit. We acknowledge your notification and have no objection to the fireworks display provided it is conducted in a manner that does not create a hazard to other persons, or their property. To enhance the safety of your event, we recommend the following actions: • Fireworks staff should remain vigilant to ensure that no aircraft are in the area prior to beginning the fireworks display. • If your event is within 5 Miles of public use airport, or if the display will exceed 500 feet Above Ground Level (AGL), contact Leidos Flight Service at 1-877-4-US-NTMS (1-877-487-6857) at least 24 hours (but not more than 72 fours) in advance to request a Notice to Airman (NOTAM). You will need to provide the following information: o Name and address of the person filing the NOTAM o Date, time(s), and event location (City, State, and location in reference to the airport) o Maximum altitude of the display This letter should not be construed as superseding or invalidating any existing rules or regulations promulgated by any other federal, state, county, or municipal government which may be required for this display. If you have any questions regarding this information. please contact our office at (404) 305- 5570 or 9-ATO-I-SA-OSG-Fireworks awfaa.pov. Sincerely, Ryan W. Almasy Manager, Operations Support Group Eastern Service Center, Air Traffic Organization 099 South Oyster Bav Road,Suite 111 6eihpage, NY,New York 11714 United States LIVE " �' � c�1� -:��}�-S� 516-597-5500 vnvw.voltlive.com America's World Class Fireworks Leader Display Date:May 25,2019 FIREWORKS DISPLAY AGREEMENT AGREEMENT made February 8, 2019 by and between Pyro Engineering,Inc.d/b/a Volt Live,whose address is 899 South Oyster Bay Road, Suite ill, Bethpage, NY 11714 (hereinafter"VOLT"); and GreeMrt Fire DeEgrtment, PO Sox 345. Greenport, NY 11944(hereinafter"SPON50R"). WHEREAS,VOLT designs,produces,and conducts fireworks displays;and WHEREAS,SPONSOR wishes to engage VOLT to design,produce and perforin a fireworks display on the terms and conditions hereinafter set forth; NOW,THEREFORE,in consideration of the terms,conditions and covenants hereinafter set forth,the parties hereto do mutually agree as follows, I.FIREWORKS DISPLAY.- On,May 2� y 5,2019(hereinafter"the Display Date"),VOLT shalt provide the fireworks and equipment for the display at the Fireworks Display location.The display will be under the supervision of a VOLT trained technician.It is agreed that VOLT shalt be the sole fireworks supplier and producer for the event contracted for herein. (Note: The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). ALTERNATE DATE. May 26.2019 2. COST ANIS PAYMENTS: FIREWORKS DISPLAY PRIG: The total (Fireworks Display Price plus all other applicable charges) sum of shalt be due and payable Night of Display. shall be paid by Dfficial Check made payable to Pyro Engineering,Inc., Please Note. SPONSOR is responsible for the payment of all governmental fees and taxes, including. but not limited to, sales, use,excise, license,permit,entertainment,or other fees,taxes or surcharges imposed or otherwise applied to this exhibition. Also, please see Section 16(c)below. 3. POSTPONEMENT/RESCHEDULING.If the display of the fireworks is postponedfrescheduled by reason of inclement weather or by determination by the governmental authority having jurisdiction,or for any other reason beyond the control of VOLT,same shall be re- scheduled to the Alternate Date set forth above. In the event a postponement/rescheduling is necessary due to inclement weather or by determination by the governmental authority having jurisdiction,or for any other reason beyond the control of VOLT a postponernenttrescheduling fee will be based on the table below. Description %of Fireworks Disolay Price Additional Costs if notified by 12;01 AM on 5124/2019 5% Any 3Ed Party Vendor Expenses If notified after 12:01 AM on 5124f2i#19 156% An 3"iPpAy Vendor Expenses Once Etay Fireworks Techs Arrive on Site 201/0 Any 31dParty Vendor Expenses Any request made by SPONSOR for rescheduling/canceling shall be directed to help@volttive,corn or by phone(516)426-0334. It is understood and agreed that VOLT shall have no obligation to reschedule a display except as required by inclement weather or reasons beyond the control of VOLT. 4, SPONSOR'S AGENT.Ed Sieban CELL.PHONE. 7,• � shall be designated as SPONSOR'S agent to whom all questions and inquiries shall be relayed. Sponsor's agent shall be the only agent of SPONSOR authorized to make decisions on behalf of SPONSOR or to request rescheduling of the fireworks display on the part of SPONSOR. ase in'tuaf each Ini[W here_ 5000r�or VOLT 1) VOLT agrees to procure)lability insurance on behalf of SPONSOR,and to indemnify SPONSOR,to the extent thereof for all claims arising out of VOLTS negligence. Any additional Insurance that is required that incurs a cost,will be the SP'ONSOR'S responsibiRtyy. 1r. SPONSORS DEFAULT In the event SPONSOR shag fail to pay any sum when due under the terms of this contract,SPONSOR shall pay.In addition to such 2ah>otmt,interest at the rate of 1.596 per month on the unpaid amount from the original due date. SPONSOR doss further agree that it shag pay VOLT reasonable attorney fm and other costs in the event VOLT shall commence any profteding(Arbitration or any ofhw proceeding)or incur fear to compel SPONSOR to pay any suras due hereunder or otherwise as a restdt of SPON.SORI default of any of the terms and provisions herein contained. 12.UWATEDDAINAGES: it is agreed by and been the parties himelo Out in the event of SPONSOR'S deft hen under COLT shall be MOW to receive the erg cmtrad pve and same shag be considered wed damagW based upon an erg Ixd+rveen the parties hereto that VOLT will haw suffered damages due to Sponsor's defame.The damages mAered by VOLT as a rem*of Sponsors deWA YA be substarsied,but capable of delmmkwoon with matmmocal pouch.It is,VwefiDra,agreW by the pates that the amount due VOLT is not a penalty,but rather a muk&*beneficial and reamnable estimate of the darnages SAWed by VOLT. 13. SUBST?TUMNS. VOLT shag have the right,at its discretion,to substitute any fireworks it deems necessary provided same does not detract frmn the aestheft value or quality of the program.This Includes,but Is not limited to,shell sizes,quantities,types and brand names. Any substitutions sham in no way result in or entitle SPONSOR to a reduction or abatement of the fug contract price. 14.ARBITRATION: Any and all disputes,dif#erences,or any o#w type of controversy arising out of or In relation to this Agreemem including as to ttte meaning or interpretation of any provision hereof.shalt be resolved by arbitration in Nam=County, Now York, pursuant to the commercial rules then obWr ft of the American Arbitration Association.Only one(1)arbitrator shag be required,and the arbitrator My award attorneys•fees.The award of the wbitr W strati be final and bktcling and Mgment may be entered thereon in any court of conpetent)urisdiction.The arbWatkx"sitting in such controversy shall have no power to atter or modify any express provision of this Agreement, nor to make awry award which by its temts effects any such alteration or modificaWn. Either party may seek from the court of competerht juriufton any provisional remedy in aid of arbiri a on,including,but not limited to,injunction. attachment or replevin,pending the determination of any claim or controversy In arbitration_ Any and all disputes,m troversies, actions,claims,causes ofaction.or proceedings ardsft under,out of,or in connection with or reiaft to the terns of this contract,and any amendment thereof,camrnenced by,between or against any of the pars of this c ontrad shall be dem to have arisen from a transaction of business in New York,and shall be resolved by appliption of the substantive laws of the State of New York. I&BINDM EFFECT This contract shag not be binding an VOLT until executed by SPONSOR arxi VOLT and VOLT Is in recent of the downpaymert required hereunder. 76. EXHIS TION PLANNER CHECKLIST(EPC): a. FIREWORKS DISPLAY EMIT: (Note: The actual start and stop time of the display will be determined by the goventmental authorities having luftdiction over the display). SPONSOR'S RESPONSIBILITY: it is Sponsor's responsibigty to call your State,City,County,Town,Borough,or Village Fre Marshal or outer appropriate authority to file for and obtain the Fireworks Display parrrut. VOLT will prepare the paperwork for the permit appiica*k n on SPONOR'S behalf. Upon recelpt of my gMit you 19M mnW the gtMft Ig gUL 2ma for our MRiM no LilikEftV 30-days odorIgi r . You must obtain information on: i- Filing application dine and fees, z. Local and state requirements for fireworks license for transportation andfor display. If a license is required,fax all forms immediately to us_ 3. Fire Marshal's requirements for security of fireworks truck upon arrival,and the security of the fire zone before and during the display. 4. Federal regulations MgWre that we carry an accurate route plan to the display site. Fax us a copy of the route instructims from the nearest US Interstate to the display area(approved by the fire marshal or other auttrority,if necessary). 5. Notify FAA on day of your display,according to the Instructions in the FAA Letter of Approval,which will be forwarded to you prior to your display. b.COAST'fiyM!?PERIiAITs(VdWe required): 1. If the fireworks are to be displayed on or near the water,the tbilovAng may be regtdred: (Requests for hermits must be fit at least 60 days prior to the Display Date(135 days prior for 4th of July events). RIM k"68ch Iron here: 7j.,._ SWON �0 T 5. E7t'NIBM4CW PLANNER CHECKLIST. It Is understood and meed by the parties hereto that the Fireworks Display shall be contingent twat tfite strict compliance by SPONSOR with all items speciliied on the Exhibition Planner Checklist(EPC)which is annexed hemta acid made a part hereof. Failure on the part of SPONSOR to comply with all requirements set forth in the EPC to the satisfaction of VOLT within the time tirade therein set forth shall be deemed to be an event of default of SPONSOR'S obligations hereunder. 5-SECURITYISAFETY SPONSOR shat!provide and maintain suffident Security before.during and after the Fireworks Display until the Pyroteclhnicxan in charge dedares the arras dear. Security Shall be deemed to Include.but not limited to,be all security lines,potim protection,sncner#ming.rope lam,barricades or any okiher item deemed necessary by the local government or by VOLT.SPONSOR shall also Provide and malnta an area dear of any buildings cars and spectators with a minimum radius as specified by current edition of NFPA Code 1123, as a Fine Safety Zane(FSZ)during the entire period commencing from the time the fitewontss are delivered to the site until the area is dedared dear by the pyrotechnician. It is understood and agreed that.VOLT will ease all fnreisorks discharge due Jo any security breach of the FSZ. VOLT shall not be responsible for personal injury.vehide or property damage occurring within the FSZ as a result of the SPONSOR's failure to maintain the FSZ in accordance with the standards of current edition of NFPA 1123 which.inddentally,are only rminknumt shwWards of distarims. SPONSOR admowledges and agrees that VOLrs responsbfi ies are limited to the Fireworks Display and that VOLT is relying on SPONSOR to maintain the aforementioned FSZ and to comply with all Federal,State,municipal and kxW[am,orders,regulations and ordinances pertaining to the implementation of any and all security measures at the site of the Fireworks D'tplay.Any site visits made dewing the display setup by or on behalf of SPONSOR shall be in accordance with the current edition of NFPA 1123-and under the direct supenrision of the VOLT ted u4cian In charge.Any such inspection shall not in any way interface with ktre safety,setup or SCNHK le of the preparation for atxi disassembly after the Fireworks Display.The VOLT tedmici do in charge may,at his discretion,cancel any inspection that in his sole opinion may compromise the safety of the setup ar tW Fireworks Display or the setup schedule. The VOLT technician may at any time temporarily discontinue the discharge of fireworks for any reason. 7.CREWS: As a material Inducement to VOLT agreeing to enter We this Agreement,SPONSOR shall give VOLT program credit as sole fireworks supplier and producer in all press releases,advertising,and any other program announcements,printed or otherwlse. S.INABILITY to DBLAAE't or CONDUCT FUWMRKS D1SPL4Y)FORCE AIAJEURE VOLT shall not Incur any liability for any toss or for any failure to perforin arty oblation hereunder due to causes beyond its reasonable control including without limitation legal or regulatory restrictions, labor lutea of whatever nature. power loss, �f m failure, acts of God, or any 011ier cause beyond its reasonable amtrnl. in the event VOLT is unable to deliver the Firteworks Display on the Delivery Date this contract will remain in full force and effect and the Firewartcs Display will be performed on the Alternate Date or if no Alternate Date is stated then on such other date as may be agreed upon by the parties. 9.CONTRACT SUBJECT TO GOV15RNMENT JWGULATWN. This Agreement and VOLTS obligations hereunder are subject to all applicable Federal,State,Municipal and local Manor&,rules,ordinances,regulations and codes,now or hereinafter in effect,and to the conditioris and limitations contained in the penWts required to be obtained by SPONSOR prior to the Fireworks Display. In the event any Federal.State,municipal or local law,fele.regulation or ordinance shall be enacted which in any way prohibits,limits or restricm the sale,perfomtance or operstion of the WMilio n of the F* works Display or in the event SPONSOR'S perrrut in any way Punks or restricts the sale,pe~srForrnance or operation of said exhibition,VOLT"stall limit or restrict its performance or the Fmmorke Display so as to comply With such law,rule.regulation or ordinance of Wri talion or restriction of SPONSOR'S permit.SPONSOR acknowledges that any such limit or mom placed on the Perfprnuinc a or operation of the Fireworks Display shall in no way result in or entMe SPONSOR to a reduction or abatement in the full contract price. 10. GENERAL PROVISIONS: a) This agreement constitutes the erre agreement between the parties relating to the subject matter hereof.and may not be cdwrVed,modified,renewed or extended except by a written agreement.signed by boats parties. SPONSOR acknowledges and agrees that VOLT has not made any representations or warranties&MW those specifically set forth in this contract. Should any douse.section,or part of this agreement be hall or dedared to the void or Illegal fir any reason,all other clauses.scions, or parts of this agreement which can be effected without such d douse,section,or part shall nevertheless continue in full force and effect. b) SPONSOR is respvnsittte far removal of paper debuts associated with the Frewarks Display. C1 VOLT IS MX MgMS e W OMMAM any marine services associated vA the production of SPONWRIS event. Show SPONSOR require these umn es,VOLT may,upon written request,assist SPONSOR In the location and contracting of such services. All additiomai costs and flees associated with marine services are the responsibility of the SPONSOR. It is 6POdficaly understood and agreed that VOLT shall not be responsible in any way N any third party service with which SPONSOR has cor*3ded for service sails to perform and the digft auviot proceed as planned. d) SPONSOR is responsible for any additional marine ousts and fees,city permWescort fees,County ISt WPDIFDIFM fees, knal town permit fees.etr- e) In the event SPONSM cancels the Fkrewoks Display the full contrad price as set forth herein WWI become Imtmediateiy due and Payable. SPONSOR will have up to 30 days from the date of cancellation to request VOLT to reschedule the Fireworks Display. Fireworks Display shall take place no later than six months from originally smiled Fireworks Display PMM MW each Nge- Irk trate: Spurr T 2. Coast Guard Application and Permit to Handle Hazardous Materials. 3. Coast Guard Marine Event Permit. c. SPONSOR RESPONSIBILITIES AND EXPENSES he following services need to be IRrovided and paid for by the SPQNSOR in addition to the Fireworks t?is Ia Price. 1) SECURITY: MUST BE PROVIDED FOR FIREWORKS TRUCK(S) AND TO MAINTAIN THE FIRE SAFETY ZONE AT STAGING AREA FROM FIREWORKS TRUCK(S)ARRIVAL, UNTIL TRUCK DEPARTURE WHICH MAY BE FOLLOWING THE REQUIRED FIRST LIGHT DUD SEARCH ON THE MORNING AFTER THE DISPLAY_ 2) Sand: Please provide 0—yards of sand. 3) Laborer(s): 0laborers to arrive at fireworks site on (They wilt not handle fireworks). 4) Hotel Roorn(s): 0—hotel rooms(within 10 miles of show site). B) Vehfcle(s): Four-wheel drive vehicle for movement on sand:Yes No XX fi) If you have ordered a set piece(s),you are responsible for erecting the scaffolding and it must be ready when the crew arrives d.RADIO SIMULCAST F_XPENSES if appOcablep 1) Set up and staff a fireworks simulcast command center on site by 1:00 PM on the display date. 2) Provide broadcast relay to VOLT Firing Center. Call our office for details. 3) Speaker system for VIP viewing stands. e.iNSURANCE' Please list below the additional insured,as they should appear on the insurance certificate; 9_ 3. 4. Name of Sonsor �r /� Y r t'� Date Volt Live Sin a Date B .i I YR�ppI y !�Ali (.A - 1. F Si [= n on half f S nsor Si nature Print Name r Gu Title of authorized re resentative of Sponsor ,,. nK Title y •/E E/E!E!■■t!E E E a!!a a E a a!■!a a■■!E a a■i s■■a ae r w ......w a a■a u a r■a w■r a i a w■r al w r w a r a a a i!a a a a 1 a■ State b[ Counh,of On the,__-_day of in the year_before me,the undersigned,a Notary Public in and for said State,personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s) is(are)subscribed to the within instrument and acknowledged to me that hefshelt cy executed the saute in histher/their capanity(ies), and that by hislherftheir signature(s)on the instrument_the individual(s),or the person upon behalf of which the individual(s)acted.executed the instrument_ Sipature and Office of individual taking acknowledgment [seat] ?lease initial each oam. Ind here: Sponsor F PYRQ ENGINEERING, INC. d/b/a Volt Live DISPLAY SITE PLAN QUESTIONNAIRE AEE items listed below are subod to aH goveming Federal.State,Municipal and local Eaves,rules,ordinances.regulations and codes,now or hereinafter In effect,and to the conditions and Dations contained in the permits required or to be obtained by Sponsor. SPONSOR:Green rt Fire De rtment Display Date . 20 i'P Rain Date: MAI '�L, "' Budget: Display Location: R ;r,� 1�F� T , Time of Display. T (Nom: The actual start and stop time of the display will be determined by the governmental authorities having Jurisdiction over the display). IMPORTANT: PLEASE PROVIDE A SITE PLAN FOR YOUR EVENT LOCATJON,INDICATING WIM AN X THE EXACT SPOT WHERE FIREWORKS ARE TO BE SET-UP. Lo"I Fire Marshal: Telephone No: Cell Phone No: Crew Contact Person: Telephone No: Cell Phone No: The Following Intormadon is necessary in order for us to provide your community or organization with a display That sanfonns with fhaewvrft faft Muladons and for the Issuance of k2Lw insurance certificate. DISTANCES,IN FEET, FROM THE FIRING AREA TO THE FOL LOMNG: FEET SPECTATORS,AUDIENCE OR PARKED CARS................................................... OCCUPIED BUILDINGS(HOMES,APARTMENTS,ETC.)..................................... PUBLIC BUILDINGS(SCHOOLS,HOSPITALS,CHURCHES,ETC.)...................... TEMPORARY EVENT SET-UPS(CONCESSIONS,TENTS,ETC.)........................... MAINPARKING AREAS..,............................................................................... HIGHWAYSOR ROADS.................................................................................. OVERHEAD OBJECTS(POWER LINES,LIGHT POLES,TREES,ETC..................... FUELSTORAGE............................................................................................. PLEASE PROVIDE DIRECTIONS FROM NEAREST INTERSTATE TO DISPLAY SITE. A MAP WOULD ALSO BE HELPFUL Local Motels Wotiels: TehgAone Nos signature Title: Date mem irftesen per. r_. smnsx T ��ellFFOLk � RESOLUTION 2019-257 y� ADOPTED DOC ID: 15032 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-257 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MARCH 26,2019: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of Fireworks Permit#2019-1 by the Town Clerk's Office to Star Hose Company of the Greenport Fire Department, for a fireworks display on May 25,2019 (r/d 5/26/19), at Greenport High School Athletic Field, Greenport,New York upon the payment of a single fee of$100 and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits and subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: James Dinizio Jr, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Dinizio Jr,Ruland,Doherty, Ghosio, Evans, Russell f , vAgVFFot/r o ELIZABETH A.NEVILLE,MMC y0 Gy Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0 • Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER J* www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT#2019-1 For PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVILLE, Town Clerk of the Town of Southold, Suffolk County, New York, being an officer duly designated by the Town Board of the Town of Southold for this purpose,do hereby GRANT TO: GREENPORT FIRE DEPARTMENT STAR HOUSE CO.,THIRD STREET,GREENPORT A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York at 10:00 PM on Saturday, May 25,2019; Raindate:Sunday, May 26,2019 on the property of GREENPORT PUBLIC SCHOOL Athletic Field, located on the north side Front Street and east side Moores Lane,Greenport,New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building„ public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line,trees or other overhead obstruction;that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines;that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour;that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. W Elizab h A. Neville,Southold Town Clerk Suffolk County, New York (Town Seal) Date: March 26, 2019 THIS PERMIT IS NOT TRANSFERABLE ELIZABETH A. NEVILLE,MMC OSVFFO[/-`,O� Town Hall,53095 Main Road TOWN CLERK �� S� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0 • Fax(631)765-6145 MARRIAGE OFFICER ,y ®�. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT#2019-1 For PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVILLE, Town Clerk of the Town of Southold, Suffolk County, New York, being an officer duly designated by the Town Board of the Town of Southold for this purpose,do hereby GRANT TO: GREENPORT FIRE DEPARTMENT STAR HOUSE CO. ,THIRD STREET, GREENPORT A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York at 10:00 PM on Saturday, May 25,2019; Raindate:Sunday, May 26, 2019 on the property of GREENPORT PUBLIC SCHOOL Athletic Field, located on the north side Front Street and east side Moores Lane,Greenport, New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction;-that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines;that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour;that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. 1 L - ------ -LIX------ --- Elizab h A. Neville,Southold Town Clerk Suffolk County, New York (Town Seal) Date: March 26, 2019 THIS PERMIT IS NOT TRANSFERABLE Neville, Elizabeth From: Fisher, Robert Sent: Thursday, March 14, 2019 3:12 PM To: Neville, Elizabeth; Duffy, Bill; Flatley, Martin; Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;Jim Dinizio; Standish, Lauren; Louisa Evans; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary;Tomaszewski, Michelle; William Ruland Subject: RE: Emailing: GFD Fireworks 5_20190311133409 Betty I inspected the site and I have no problem with this event taking place as planned. Bob Robert Fisher Fire Marshal,Town of Southold robert.fisher@town.southold.ny.us (W) 631-765-1802-(C) 631-786-9180 PRIVILEGED AND CONFIDENTIAL COMMUNICATION CONFIDENTIALITY NOTICE:This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender immediately by e-mail and delete the original message. -----Original Message----- From: Neville, Elizabeth Sent: Monday, March 11, 2019 1:43 PM To: Duffy, Bill <billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatlev@town.southold.nv.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Doherty,Jill <fill.doherty@town.southold.ny.us>; Doroski, Bonnie<Bonnie.Doroski@town.southold.nv.us>; Duffy, Bill <billd@southoldtownny.gov>; Ghosio, Bob<bob.ghosio@town.southold.ny.us>; Hagan, Damon <damonh@southoldtownny.gov>;Jim Dinizio<jim@iamesdinizio.com>;Standish, Lauren <Lauren.Standish@town.southold.ny.us>; Louisa Evans<Ipevans06390@gmail.com>; Neville, Elizabeth <E.Neville@town.southold.nv.us>; Noncarrow, Denis<denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell, Scott<scottr@southoldtownny.gov>; Silleck, Mary <marvs@town.southold.nv.us>;Tomaszewski, Michelle <michellet@town.southold.ny.us>; William Ruland <rulandfarm@yahoo.com> Subject: Emailing: GFD Fireworks 5_20190311133409 Importance: High Transmitted herewith is the application of the Greenport Fire Department for their May 25, 2019 (rd:5/26/19) Fireworks Display. Please review and advise of any concerns, questions and/or objections you may have to the granting of this Fireworks Permit. 1 Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Fireworks 520190311133409 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 2 Neville, Elizabeth From: Flatley, Martin Sent: Monday, March 11, 2019 4:38 PM To: Neville, Elizabeth Subject: RE: Emailing: GFD Fireworks 5_20190311133409 1 have no objections to this event being approved as in the past. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent: Monday, March 11, 2019 1:43 PM To: Duffy, Bill<billd@southoldtownnv.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatlev town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.nv.us>; Doroski, Bonnie<Bonnie.Doroski@town.southold.ny.us>; Duffy, Bill <billd@southoldtownny.gov>; Ghosio, Bob<bob.ghosio@town.southold.ny.us>; Hagan, Damon <damonh@southoldtownny.gov>;Jim Dinizio<iim iamesdinizio.com>; Standish, Lauren <Lauren.Standish@town.southold.ny.us>; Louisa Evans<Ipevans06390@gmail.com>; Neville, Elizabeth <E.Neville @town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell, Scott<scottr@southoldtownny.gov_>; Silleck, Mary <marvs@town.southold.ny.us>;Tomaszewski, Michelle<michellet@town.southold.ny.us>; William Ruland <rulandfarm@vahoo.com> Subject: Emailing: GFD Fireworks 5_20190311133409, Importance: High Transmitted herewith is the application of the Greenport Fire Department for their May 25, 2019 (rd:5/26/19) Fireworks Display. Please review and advise of any concerns, questions and/or objections you may have to the granting of this Fireworks Permit. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Fireworks 520190311133409 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. I Neville, Elizabeth From: Spiro, Melissa Sent: Monday, March 11, 2019 1.48 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert; Flatley, Martin; Doherty, Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;Jim Dinizio; Standish, Lauren; Louisa Evans; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary;Tomaszewski, Michelle; William Ruland Subject: RE: Emailing: GFD Fireworks 5_20190311133409 This is not preserved lands. Melissa -----Original Message----- From: Neville, Elizabeth Sent: Monday, March 11, 2019 1:43 PM To: Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Doherty,Jill <iill.doherty@town.southold.nv.us>; Doroski, Bonnie<Bonnie.Doroski@town.southold.ny.us>; Duffy, Bill <billd@southoldtownny.Rov>; Ghosio, Bob<bob.ghosio@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownny.gov>;Jim Dinizio <iim@iamesdinizio.com>; Standish, Lauren <Lauren.Standish@town.southold.ny.us>; Louisa Evans<lpevans06390@Rmail.com>; Neville, Elizabeth <E.Neville @town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.Rov>; Rudder, Lynda <Ivnda.rudder@town.southold.nv.us>; Russell, Scott<scottr@southoldtownny.gov>; Silleck, Mary <marvs@town.southold.nv.us>;Tomaszewski, Michelle<michelletCa@town.southold.ny.us>; William Ruland <rulandfarm@yahoo.com> Subject: Emailing: GFD Fireworks 5_20190311133409 Importance: High Transmitted herewith is the application of the Greenport Fire Department for their May 25, 2019 (rd:5/26/19) Fireworks Display. Please review and advise of any concerns, questions and/or objections you may have to the granting of this Fireworks Permit. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Fireworks 520190311133409 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. Neville, Elizabeth From: Neville, Elizabeth Sent: Monday, March 11, 2019 1.43 PM To: Duffy, Bill; Fish Obert; Fla , artin; SpirhrlVrelissa; Doherty, Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon; 'James Dinizio'; Standish, Lauren; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary; Tomaszewski, Michelle;William Ruland Subject: Emailing: GFD Fireworks 5_20190311133409 Attachments: GFD Fireworks 5_20190311133409.pdf Importance: High Transmitted herewith is the application of the Greenport Fire Department for their May 25, 2019 (rd:5/26/19) Fireworks Display. Please review and advise of any concerns, questions and/or objections you may have to the granting of this Fireworks Permit. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Fireworks 520190311133409 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. CHIEF JEFFREY WEINGART F , (631)477-9801 -STATION 1 1sTASST.CHIEF SUSANO JIMENEZ (631)477-8261 -STATION 2 2ND ASST.CHIEF JAMES KALIN ��` (631)477-1943-CHIEFS OFFICE (631)477-4012-FAX CHAPLAIN CLAUDE KUMJIAN EJ 311 THIRD STREET•P.O.BOX 58 ASST.CHAPLAIN THOMAS MURRAY , GREENPORT,NY 11944 Email:gfdfire@optonline.net SECRETARYITREASURER JAMES KALIN www.greenportfd.org Organized 1845 RECEIVE® LIN - 8 201@ February 27, 2019 Southold Tawn Clerk To Whom it May Concern, The Star Hose Co. #3 of the Greenport Fire Department will be having a fireworks display on Saturday, May 25, 2019. A rain date will be Sunday, May 26, 2019. The display will be shot from the athletic fields of the Greenport Public School. Greenport Fire Department will be standing by with two (2)fire engines and any additional apparatus as needed. If you have any questions please feel free to contact me at the phone number above. incerely, l James H. Kalin 2nd.Ass't. Chief SO�j�ol ELIZABETH A.NEVI LLE O Town Hall,53095 Main Road TOWN CLERKP.O.Box 1179 REGISTRAR OF VITAL STATISTICS G Southold;New York 11971 MARRIAGE OFFICER • COQ Fag(631) 765-6145 RECORDS MANAGEMENT OFFICER Oly ' Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �OUI�f f`l,� southoldtown.northfork.net RECEIVED OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD MAR - 8 2019 APPLICATION PERIWr TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law df the State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY.5_ '\ t�a 5 e Cv. - Gefl to r PRINCIPAL OFFICE AT o �� G s?fleh A),r N 09 q DATE&TIME OF DISPLAY O EXACT LOCATION OF DISPLAY (�' �� u Pva �-I c S o, - T G.►S r 1 SUFFOLK COUNTY TAX ER FOR SITE RAV DATE&TIlVIE The following persons are to be in charge of the actual shooting of the fireworks: Name Ae Experience Physical Condition ���1.,►�� L a r-r��.i�as ,>A! (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Manner and place of storage of firewoks prior to display: w Li vs,-$d jrZ� b}s is PL,-S � r-A rJ Mn 7'14 Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,with signature of the Property Owner,must be submitted with the Application. 57"A 14&3T C, 03 Name of Organization By a" Signature of Applicant v , �/ Date of Application Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 03/08/19 Receipt#: 251992 Quantity Transactions Reference Subtotal 1 Fireworks 5.25.19 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#1510 $100.00 Star, Hose Company Co#3 Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Star, Hose Company Co#3 Greenport Fire Department Po Box 345 240 6th Ave Clerk ID: BONNIED Internal ID 5.25 19 ac0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 01/08/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: Donna Ackroyd Mcmann Price Agency IncAHICONN Es : (631)477-1680 AXMIC Ne; (631)477-8930 828 Front Street ADDRESS:: donna@mcmannpnce.com P.O.BOX 2085 INSURER(S)AFFORDING COVERAGE NAIC p Greenport NY 11944-0876 INSURER A: Arch Insurance Company INSURED INSURER B: Village of Greenport Fire Department INSURER C: PO Box 58 INSURER D: INSURER E: Greenport NY 11944-0058 INSURER F: COVERAGES CERTIFICATE NUMBER: CL191802359 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE IND WVD POLICY NUMBER MM/OD/YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAWS-MADEa OCCUR PREMISES Es occurrence $ 100,000 MED EXP(Any oneperson) S 5,000 A Y MEPK06726913 06/0112018 06/01/2019 PERSONAL BADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 10,000,000 POLICY❑JEST LOC PRODUCTS•COMPIOP AGG S 10,000,000 OTHER: Liquor Liab.COV.Part s 3,000,000 AUTOMOBILE LIABILITY COMBINED SING LI IT S Ea eccldent ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY ) AUTOS ONLY AUTOS (Per accident S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY =dent) S X UMBRELLA LIAB X OCCUREACH OCCURRENCE S 5,000,000 A EXCESS LIAR CLAIMS-MADE MEUM06473413 06/01/2018 06/01/2019 AGGREGATE s 5,000,000 DED I I RETENTION S $ WORKERS COMPENSATION0TH• AND EMPLOYERS'LUIBtUTY y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) It yea,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E L DISEASE•POLICY LIMIT $ R CEIVED DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schodulo,maybe attached If more apace Is required) With respect to Star Hose Carnival from May 23 to May 26,2019 NAR 1 019 Southold Town Clerk CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL,BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 UTH IZED REPR NTIV r Southold i z I \ NY 11971 V-1988-2016AA D CORPORATIO . All rights reserved. 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"�;t&dI'�.`�,u' b,�,ti,�'��'rnk '��r�fi� ; Q•.�',, 5; ''��. .,L,, a'', �,�1,�5���+ �,7Y`^' s�, �� ':'8 s d;;� �� ,! ��_.x ��,"5 =,s;5ktip F•: "'� w r3".,.$;�;� 3 '��'� 4 y' t .4 4S�'��,�` �,�....�, 4; ,.=.✓."�,'�;r�'e^��,Y ,wrk9'7a- l ':y�,£ ], " h ��. �` J a iSl � -h.;: ',ytf"^ n.c, Y+u"•tgh� +%, y�o�71: ,.-;5,� '�`�. � 999 South Ovster Bay Road.Suite 111 6ethpagd,NY,New York 11714 '® %ff&1 ■ United States V �� 5 i _J 91_C� �'JI 516-597-5500 e=v.voltlive.com America's World Class Fireworks Leader Display Date:May 25,2019 FIREWORKS DISPLAY AGREEMENT AGREEMENT made February 8,2019 by and between Pyro Engineering,Inc.dlbla Volt Live,whose address is 999 South Oyster Bay Road, Suite 111, Bethpage, NY 11714 (hereinafter"VOLT'); and Greenport t=ire Department, PO Box 345 Greenport, NY 11944(hereinafter"SPONSOR"). WHEREAS,VOLT designs,produces,and conducts fireworks displays;and WHEREAS,SPONSOR wishes to engage VOLT to design,produce and perform a fireworks display on the terms and conditions hereinafter set forth: NOW,THEREFORE,in consideration of the terms,conditions and covenants hereinafter set forth.the parties hereto do mutually agree as follows. 1.FIREWORKS DISPLAY- On,May 25,2019(hereinafter"the Display Date"),VOLT shall provide the fireworks and equipment for the display at the Fireworks Display location.The display will be under the supervision of a VOLT trained technician.It is agreed that VOLT shall be the sole fireworks supplier and producer for the event contracted for herein. (Note- The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). ALTERNATE DATE: Mav 26.2019 2. COST AND PAYMENTS: FIREWORKS DISPLAY PRICE: $5,000.00 The total (Fireworks Display Price plus all other applicable charges) sum of $5,000.00 shall be due and payable Night of Display. shall be paid by Official Check made payable to Pyro Engineering,Inc., Please Note: SPONSOR is responsible for the payment of all governmental fees and taxes, including, but not limited to, sales, use,excise,license,permit,entertainment,or other fees,taxes or surcharges imposed or otherwise applied to this exhibition. Also, please see Section 16(c)below. 3. POSTPONEMENT/RESCHEDULING:If the display of the fireworks is postponedfrescheduled by reason of inclement weather or by determination by the governmental authority having jurisdiction,or for any other reason beyond the control of VOLT,same shall be re- scheduled to the Alternate Date set forth above_ In the event a postponementfrescheduling is necessary due to inclement weather or by determination by the governmental authority having jurisdiction,or for any other reason beyond the control of VOLT a poslponementfrescheduling fee will be based on the table below. I Description I %of Fireworks Display Price I Additional Costs If notified by 12:01 AM on 5124/2019 5% Any 31"Paq Vendor Expenses If notified after 12:01 AM on 5/2412019 15%, Any 31d Party Vendor Expenses Once Bay Fireworks Techs Arrive on Site 20% An 3rd Pa Vendor Expenses Any request made by SPONSOR for reschedulinglcance6ng shall be directed to help@voltiive,com or by phone(516)426-0334. It is understood and agreed that VOLT shall have no obligation to reschedule a display except as required by inclement weather or reasons beyond the control of VOLT. 4.SPONSORS AGENT:Ed Sieban CELL PHONE. shall be designated as SPONSORS agent to whom all questions and inquiries shall be relayed. Sponsor's agent shall be the only agent of SPONSOR authorized to make decisions on behalf of SPONSOR or to request rescheduling of the fireworks display on the part of SPONSOR- Please PONSORPlease inial each Dan �t f Inifat here: 1 Sponsor !!VOLT f) VOLT agrees to procure riability insurance on behalf of SPONSOR,and to indemnify SPONSOR,to the extent thereof,for all claims arising out of VOLrs;negligence. Any additional insurance that is required that incurs a cost,will be the SPONSOR'S responsibility. 11.SPONSORS;DEFAULT- In the event SPONSOR shall fail to pay any stun when due under the terms of this contract.SPONSOR shall pay,in addition to such amount,interest atthe rate of 1.5°/6 per month on the unpaid amount from the original due date. SPONSOR does further agree that it shall pay VOLT reasonable attorney fees and other costs in the event VOLT shall commence any proceeding(Arbitration or any other proceeding)or incur fees to compel SPONSOR to pay any sums due hereunder or otherwise as a result of SPONSOR'S default of any of the terms and provisions herein contained. 12 LIQUIDATED DAMAGES: It is agreed by and between the parties hereto Win the event of SPONSOR'S default hereunder VOLT shall be entitled to receive the entire contract price and same shall be considered"liquidated damages'based upon an understanding between the parties hereto that VOLT VA have suffered damages due to Sponsors default The damages suffered by VOLT as a result of Sponsor's defauft will be substantial,bort incapable of determination with mathematical precision.it is,therefore,agreed by the parties that theammmt due VOLT is nota penalty,but rathera mutually benetidal and reasonable estimate ofthe damages suffered by VOLT. 13.SUBS77TUTIONS. VOLT shall have the right,at its discretion,to substitute any fireworks it deems necessary provided same does not detract from the aesthetic value or quality of the program.This includes,but is not limited to,shell sizes,quantities,types and brand names. Any substitutions shall in no way result in or entitle SPONSOR to a reduction or abatement of the full contract price. 14L ARBITRATION: Any and all disputes,differences,or any other type of controversy arising out of or in relation to this Agreemer_ including as to the meaning or interpretation of any provision hereof.shall be resolved by arbitration in Nassau County, New York, pursuant to the commercial rules then obtaining of the American Arbitration Association.Only one(1)arbitrator shag be required,and the arbitrator may award attorneys'fees.The award of the arbitrator shall be final and binding and judgment may be entered thereon in any court of competent jurisdiction.The arbitrator sitting in such controversy shall have no power to alter or modify any express provision of this Agreement,nor to make any award which by its terms effects any such alteration or modification. Either party may seek from the court of competent jurisdiction any provisional remedy in aid of arbitration,including,but not limited to.injunction, attachment or replevin,pending the determination of any claim or controversy in arbitration. Any and all disputes,controversies, actions,claims,causes of action,or proceedings arising under,out of.or in connection with or relating to the terms of this contract and any amendment thereof,commenced by,between or against any of the parties of this contract shall be deemed to have arisen from a transaction of business in New York,and shall be resolved by application of the substantive laws of the State of New York. I&BINDING EFFECT-This contract shall not be binding on VOLT until executed by SPONSOR and VOLT and VOLT is in receipt of the downpayment re Wred hereunder. It EXHiBIT70M PLANNER CHECKLIST(EPQ. a. FIREWORKS DISPLAY PERMIT: (None: The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the dlspiay). SPONSOR'S RESPONSi91U1Y: It is Sponsor's responsibility to plc your State.City,County.Town,Borough,or Village Fre Marshal or other appropriate authority to file for and obtain the Fireworks Display penniL VOLT will prepare the paperwork for the permit application on SPONOR'S behalf_ Upon receipt of your permit,you must send the permit to our office for our records no later than 30 days prior to your display date Failure to do so could seriously jeopardize your display. You must obtain inforrnahon on: 1. Filing application deadline and fees. z local and state requirements for fireworks license for transportation and/or display. If a license is required,fax all forms immediately to us. 3. Fine Marshals requirements for security of fireworks truck upon arrival,and the security of the fire zone before and during the display. 4. Federal regulations require that we carry an accurate route plan to the display site. Fax us a copy of the route instructions from the nearest US Interstate to the display area(approved by the fire marshal or other authority,if necessary). 5- Notify FAA on day of your display,according to the instructions in the FAA Letter of Approval,which will be forwarded to you prior to your display. b-COAST GUARD PERMITS(where reouirad): 1. if the fireworks are to be displayed on or near the water,the following may be required: (Requests for permits must be filed at least 60 days prior to the Display Date(135 days prior for 4th of July events)- Plem irttial each paae In�alhei� /.- ` ( SAorisor VOLT S. EMIBiTION PLANNER CHECKLIST It is understood and agreed by the parties hereto that the Fireworks Display shall be contingent upon the strict compliance by SPONSOR with all items specified on the Exhibition Planner Checklist(EPQ which is annexed hereto and made a part hereof. Failure on the part of SPONSOR to comply with all requirements set forth in the EPC to the satisfaction of VOLT within the time limits therein set forth shall be deemed to be an event of default of SPONSORS obligations hereunder. 6.SECURR Y/SAFETY SPONSOR shall provide and maintain sufficient Security before,during and after the Fireworks Display until the pyrotechnician in charge declares the area dear. Security shall be deemed to include,but not limited to,be all security lines,police protection,snow fencing.rope lines,barricades or any other item deemed necessary by the local government or by VOLT.SPONSOR shall also provide and maintain an anis dear of any buildings cars and spectators with a minimum radius as specified by current edition of NFPA Code 1123, as a Fire Safety Zone(FSZ)during the entire period commencing from the time the fireworks are delivered to the .site until the area is declared dear by the pyrotechnicran. It is understood and agreed that VOLT will cease all fireworks discharge due io any security breach of the FSZ. VOLT shall not be responsible for personal injury.vehicle or property damage occurring within the FSZ as a result of the SPONSOR's fanum to maintain the FSZ in accordance with the standards of currerit edition of NFPA 1123 which,incidentally,are only minimum standards of distances. SPONSOR acknowledges and agrees that VOLTs responsibilities are limited to the Fireworks Display and that VOLT is relying on SPONSOR to maintain the aforementioned FSZ and to comply with all Federal.State,municipal and local laws,orders,regulations and ordinances pertaining to the implementation of any and all security measures at the site of the Fireworks Display.Any site visits made during the display setup by or on behalf of SPONSOR shall be in accordance with the current edition of NFPA 1123-and under the direct supervision of the VOLT technician in charge.Any such inspection shall not in any way interfere with the safety,setup or schedule of the preparation for and disassembly after the Fireworks Display.The VOLT technician in charge may,at his discretion,cancel any inspection that in his sole opinion may compromise the safety of the setup or the Fireworks Display or the setup schedule_ The VOLT technician may at any time temporarily discontinue the discharge of fireworks for any reason. t.CREDITS. As a material inducement to VOLT agreeing to enter into this Agreement,SPONSOR shall give VOLT program credit as sole fireworks supplier and producer in all press releases,advertising,and any other program announcements,printed or otherwise. 8.INABIUTY to DELIVER or CONDUCT FIREWORKS DISPLAYlFORCE MAJEURE VOLT shall not incur any liability for any toss or for any failure to perform any obligation hereunder due to causes beyond its reasonable control including without firnitation legal or regulatory restrictions, labor disputes of whatever nature, power loss, telecommunications failure; acts of God, or any other cause beyond its reasonable control. In the event VOLT is unable to deliver the Fireworks Display on the Delivery Date this Contract will remain in full force and effect and the Fireworks Display will be performed on the Alternate Date or if no Alternate Date is stated then on such other date as may be agreed upon by the parties. 9.CONTRACTSUBJECT TO GOVERNMENT REGULATION: This Agreement and VOLT's obligations hereunder are subject to all applicable Federal,State,Municipal and local laws,rules,ordinances,regulations and codes,now or hereinafter in effect,and to the conditions and limitations contained in the permits regtdred to be obtained by SPONSOR prior to the Fireworks Display. In the event any Federal.State.municipal or local law.rule,regulation or ordinance shall be enacted which in any way prohibits,limits or restricts the sale,peftirmance or operation of the exhibition of the Fireworks Display or in the event SPONSOR'S permit in any way limits or restricts the sale,performance or operation of said exhibition,VOLT shall limit or restrict its performance or the Fireworks Display so as to comply with such law,rule,regulation or ordinance or limitation or restriction of SPONSORS permit.SPONSOR acknowledges that any such limit or restriction placed on the performance or operation of the Fireworks Display shall in no way result in or entitle SPONSOR to a reduction or abatement in the full contract price. 10. GENERAL PROVISIONS; a) This agreement constitutes the entire agreement between the parties relating to the subject matter hereof,and may not be changed,modified,renewed or extended except by a written agreement signed by both parties. SPONSOR acknowledges and agrees that VOLT has not made any representations orwarranties except those specifically set forth in this contract- Should any clause,section,or part of this agreement be held or declared to be void or illegal for any reason,all other clauses,sections, or parts of this agreement which can be effected without such illegal clause,section.or part shall nevertheless continue in full force and effect. b) SPONSOR is responsible for removal of paper debris associated with the Fireworks Display. C) VOLT is not responsible for procuring any marine services associated with the production of SPONSOR%event. Should SPONSOR require these services,VOLT may,upon written request,assist SPONSOR in the location and contracting of such services. All additional costs and fees associated with marine services are the responsibility of the SPONSOR. It is specifically understood and agreed that VOLT shall not be responsible in anyway if any third party service with which SPONSOR has contracted for service fails to perform and the display cannot proceed as planned. d) SPONSOR is responsible for any additional marine costs and fees,city permitlescort fees,County 1StatelPD1FD/FM fees, local town permit fees,etc- e) tae) In the event SPONSOR cancels the Fireworks Display the full contract price as set forth herein shall become immediately due and payable. SPONSOR will have up to 30 days from the date of cancellation to request VOLT to reschedule the Fireworks Display_ Fireworks Display shall take place no later than six months from originally scheduled Fireworks Display Reaseini1faleach nags itial Inhate l 674 sperisar ,V OI�LT 2. Coast Guard Application and Permit to Handle Hazardous Materials. 3_ Coast Guard Marine Event Permit. c SPONSOR RESPONSIBILITIES AND EXPENSES(The following services need to be provided and paid for by the SPONSOR to addition to the Fireworks Display Price 1) SECURITY: MUST BE PROVIDED FOR FIREWORKS TRUCK(S) AND TO MAINTAIN THE FIRE SAFETY ZONE AT STAGING AREA FROM FIREWORKS TRUCK(S)ARRIVAL. UNTIL TRUCK DEPARTURE WHICH MAY BE FOLLOWING THE REQUIRED FIRST LIGHT DUD SEARCH ON THE MORNING AFTER THE DISPLAY. 2) Sand: Please provide_0_vards of sand. 3) Laborer(s): 0_laborers to arrive at fireworks site on (They will not handle fireworks). G) Hotel Room(s): 0 hotel rooms(within 10 miles of show site)- 5) Vehicle(s): Four-wheel drive vehicle for movement on sand:Yes No XX S) If you have ordered a set piece(s),you are responsible for erecting the scaffolding and it must be ready when the crew anrives d-RADIO SIMULCAST EXPENSES(if applicable,,: 1) Setup and staff a fireworks simulcast command center on site by 1:00 PM on the display date. 2) Provide broadcast relay to VOLT Firing Center. Call our office for details. 3) Speaker system for VIP viewing stands. e-INSURANCE: Please list below the additional insured,as they should appear on the insurance certificate: 12. 4 i / Name of S onsor f'�== Date 'Volt Live Si natude ` Date Signed W on 4ehalf Af S onsor(Signature) I Print Name.f %? 1'YI L %V Lt%(u r Title of authorized relgresentative of Sponsor ? ��.. <<• Title 7'� ;,y1 [E-77 State of County of On the_day of -in the',car_before me,the undersigned.a Notary Public in and for said State-personally appeared personally[mown to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose namc(s) is(are)subscribed to the within instrument and aeknowledeed to me that belshe/thev executed the same in his/her/their capaciq,(ies),and that by his/her/their signature(s)on the instrument-the individual(s).-or the person upon behalf of which the individual(s)acted-executed the instrument. 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I ID-!E -r��u °�:1°iii f i ';': CHIEF JEFFREY WEINGART ' ' (631)477-9801 -STATION 1 iSTASST.CHIEF SUSANO JIMENEZ (631)477-8261 -STATION 2 (631)477-1943-CHIEFS OFFICE 2ND ASST.CHIEF JAMES KALIN (631)477-4012-FAX CHAPLAIN CLAUDE KUMJIAN 311 THIRD STREET•P.O.BOX 58 GREENPORT,NY 11944 ASST.CHAPLAIN THOMAS MURRAY FIRE DEPTLONG IS AND NEM YORK Email:gfdfire@optonline.net SECRETARY[TREASURER JAMES KALIN I, _ - www.greenportfd.org Organized 1845 February 27, 2019 To Whom it May Concern, The Star Hose Co. #3 of the Greenport Fire Department will be havinga fireworks display on Saturday, May 25, 2019. A rain date will be Sunday;-May 26, 2019. The display will be shot from the athletic fields of the Greenport'Public School.' Greenport Fire Department will be standing by with two (2)fire engines and any additional apparatus as needed. If you have any,questions please feel free to contact me at the phone number above. incerely, lKa James H. lin 2nd.Ass't. Chief